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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of <br /> Zoning Administrator v 0 �z <br /> APPLICATION FOR LAND USE PERMITS 3 ° <br /> 0 <br /> N � <br /> V <br /> Zi- <br /> OWNER COWNER TELEPHONE 7 �?D <br /> bo <br /> / 1 /, <br /> HOME ADDRESS 0 <br /> 3 D J n r A 0 g� ��/V�Gf h (� W <br /> EMERGENCY/FIRE NUMBER `7� 1 ROAD NAME 45 <br /> �-°°ff✓//� <br /> LEGAL DESCRIPTION(see tax receipt) <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE ❑ ADDITION ❑ PRIVY ❑ ti 0 <br /> TYPE OF PERMIT(S): C <br /> CT <br /> FILLING/GRADING ❑ CCAMPING UNIT ❑ SUBDIVISION ❑ L/ A °+ <br /> 5. <br /> STRUCTURE/ADDITION USE: ,77Y /''7cq V- 7K1 �i Zay /4 LJL//(� 0 S� <br /> (Hlome/Ca in; Commercial Business; Bedroom; Deck; etz <br /> BUILDING CONTRACTOR: S efit <br /> / <br /> v <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 8%X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED, m .. <br /> M N <br /> DIRECTIONS FOR PLOT PLAN DRAWING• (AERIAL OR TOP VIEW) 0 <br /> m o. <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. Z <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE <br /> M m � <br /> NORTH(N). C 0 <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO CO) 3 <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS,ROADS, LAKE, LOT LINES. <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. c <br /> o <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAY BE DONE WHEN a I <br /> NEEDED. Ct r n <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. o r ') <br /> CONDITIONS OF PERMIT: <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT <br /> ISSUANCE. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. l <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (AI <br /> PERMITTED. <br /> 4. NO STRUCTURESS, INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> 5. <br /> SETBACK <br /> aX ro <br /> XZ' 3C 0Co <br /> s. �1�-��C� �t.l! E2a�t 7th <br /> � D C 0' 3 <br /> CD C m N � <br /> 7. Z : y (OD� <br /> o <br /> I declare that this application (including any accompanying schedule) has been examined by me and to the best of my Qf 6 2 p <br /> knowledge and belief it is true, correct and complete. I acknowledge that I am responsible for the detail and accuracy of m 0CL C <br /> all information contained in this application(including any accompanying schedule)and I further declare that I recognize E m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- p <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am m <br /> providing in this application. I agree to permit county officials charged with administering county ordinances or other m <br /> authorized person to have access to the above describqo premises at any reasonable time for the purpose of inspection. m <br /> : <br /> SIGN HERE d ` <br /> (signatur of wner or building co fao�r) (date) <br /> ZONING ADMINISTRATOR <br /> to to cnwwtn� <br /> N N (INNfT U1 <br /> CT (l� 0 VINOO <br /> WNSHIP PERMITS MAY BE REQUIRED 0000000 <br />